Page 53 - 南京医科大学学报自然科学版

第44卷第2期 南京医科大学学报（自然科学版）
2024年2月 Journal of Nanjing Medical University（Natural Sciences） ·191 ·

·临床研究·

偏头痛患者合并中量右向左分流卵圆孔未闭行介入封堵术的

疗效分析

张 悦 ，娄宇轩 ，王艺斐 ，黄婉琳 ，张 浩 ，史 倞 ，盛燕辉 1，3*
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南京医科大学第一附属医院心血管内科，江苏 南京 210029；东南大学医学院，江苏 南京 211189；南京医科大学附属
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苏州医院心血管病中心，南京医科大学姑苏学院，江苏 苏州 215008
［摘 要］ 目的：通过对比介入封堵治疗偏头痛合并中、大量右向左分流（right⁃to⁃left shunt，RLS）卵圆孔未闭（patent foramen
ovale，PFO）患者的手术难度与近期疗效，评价偏头痛伴中量RLS⁃PFO患者行介入封堵的可行性。方法：入选偏头痛合并中量
或大量RLS⁃PFO并行介入封堵的患者95例，分析两组患者的偏头痛症状、封堵成功率、封堵难度、术后RLS量及术后头痛缓解

水平的差异。结果：两组术前头痛影响测试⁃6（headache impact test⁃6，HIT⁃6）、偏头痛残疾评估量表（migraine disability as⁃
sessment questionnaire，MIDAS）评分无统计学差异（P＞0.05）；两组封堵成功率无统计学差异（92.00% vs. 98.57%，P=0.137），但
中量 RLS⁃PFO 组术中第 2 根导丝使用率、心腔内超声利用率及 X 线曝光时间明显高于大量 RLS⁃PFO 组（P<0.01）；中量 RLS⁃
PFO组术后3 d有效封堵率高于大量RLS⁃PFO组（86.96% vs. 56.52%，P=0.008），两组间术后1个月、3个月、6个月RLS量及有效
封堵率无统计学差异（P＞0.05）；两组患者术后6个月HIT⁃6和MIDAS评分较术前改善（P<0.001），但中量RLS⁃PFO组术后6个
月HIT⁃6评分较大量RLS⁃ PFO组下降（P=0.012），而MIDAS评分无统计学差异。结论：偏头痛合并中量RLS⁃PFO患者行介入
封堵的手术难度较大量RLS⁃ PFO高，但介入封堵后头痛缓解疗效两组相似。
［关键词］ 卵圆孔未闭；偏头痛；介入封堵术；右向左分流
［中图分类号］ R541.1 ［文献标志码］ A ［文章编号］ 1007⁃4368（2024）02⁃191⁃06
doi：10.7655/NYDXBNSN230767

Efficacy of interventional closure of patent foramen ovale in migraine patients with
moderate right⁃to⁃left shunt

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ZHANG Yue ，LOU Yuxuan ，WANG Yifei ，HUANG Wanlin ，ZHANG Hao ，SHI Jing ，SHENG Yanhui 1，3*
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1 Department of Cardiology，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029；Southeast
University School of Medicine，Nanjing 211189；Center for Cardiovascular Diseases，the Affiliated Suzhou Hospital of
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Nanjing Medical University，Gusu School，Nanjing Medical University，Suzhou 215008，China
［Abstract］ Objective：To evaluate the feasibility of interventional closure in migraine patients with moderate right⁃to⁃left shunt
patent foramen ovale（RLS⁃PFO）by comparing the surgical difficulty and short⁃term efficacy between patients with moderate or large
RLS⁃PFO. Methods：A total of 95 patients with migraine accompanied by moderate or large RLS⁃PFO who underwent interventional
closure were selected. The differences inmigraine symptoms，closure success rate，closure difficulty，postoperative RLS volume and
postoperative headache relief level were analyzed. Results：There was no significant difference in preoperative headache impact test⁃6
（HIT⁃6）and migraine disability assessment questionnaire（MIDAS）scores between the two groups（P＞0.05）. There was no difference
in closure success rate between the two groups（92.00% vs. 98.57%，P=0.137），but the usage rate of the second guidewire，intracardiac
ultrasound utilization rate，and X⁃ray exposure time were significantly higher in the moderate RLS⁃PFO group than in the large RLS⁃
PFO group（P < 0.01）. The effective closure rate at 3 days after the procedure was higher in the moderate RLS⁃PFO group than in the
large RLS⁃PFO group（86.96% vs. 56.52%，P=0.008），but there were no differences in RLS volume and effective closure rate at 1
month，3 months and 6 months after operation between the two groups（P＞0.05）. The HIT⁃6 and MIDAS scores were improved at 6

［基金项目］ 国家自然科学基金（81800313）；南京医科大学姑苏学院引进人才项目（GSRCKY20210203）
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通信作者（Corresponding author），E⁃mail：yhsheng@njmu.edu.cn